Bilateral Lateral Rectus Recession Group Research Articles

Outcomes for Intermittent Exotropia Using Three Common Surgical Approaches.

To compare a single surgeon's surgical outcomes for treating intermittent exotropia using bilateral lateral rectus recession (BLR), unilateral lateral rectus recession and medial rectus resection (RR), and unilateral lateral rectus recession and medial rectus plication (RP). A retrospective review of all surgeries for basic intermittent exotropia between 2015 and 2023 was performed. Only patients with initial correction using BLR, RR, or RP were included. Exclusion criteria included age older than 18 years, vertical deviation, any nonrefractive ocular diagnoses, prior ocular surgery, and inadequate follow-up. There were 460 patients identified; 123 met inclusion criteria with 54 in the BLR group, 41 in the RR group, and 28 in the RP group. The average preoperative distance alignment (and standard error) values for the BLR, RR, and RP groups were 25.07 (7.35), 22.44 (5.95), and 23.84 (6.42) prism diopters (PD), respectively. At 1 year, the postoperative distance alignment values for the BLR, RR, and RP groups were 8.72 (7.89), 7.46 (6.31), and 12.83 (6.82) PD, respectively (P = .03). A subanalysis found a significant difference between the BLR and RP (P = .02) and RR and RP (P = .02) groups. There was no difference between the BLR and RR groups (P = .57). This study of three surgical approaches for intermittent exotropia found RP had a significantly larger angle of exodeviation compared to BLR and RR at 1 year of follow-up. Both BLR and RR were equally effective approaches for treating intermittent exotropia. [J Pediatr Ophthalmol Strabismus. 20XX;XX(X):XX-XX.].

Comparison of Surgical Outcomes of Two-muscle Surgery in Children with Large-angle Intermittent Exotropia

Purpose: To evaluate the long-term results of 2-muscle surgery in children with large-angle intermittent exotropia (IXT), comparing bilateral lateral rectus recession (BLR) with unilateral lateral rectus recession & medial rectus resection (RR).Methods: Ninety-two children with IXT of 40 prism diopter or more, who underwent BLR or RR were included in this retrospective study. Final successful alignment rates, and cumulative probabilities of surgical success at 3 years postoperatively were analyzed and compared using Kaplan-Meier survival analysis between the two groups.Results: At 3 years after surgery, 37 (67.3%) of 55 patients in the BLR group achieved successful alignment; 18 (32.7%) had undercorrection, and none of them had overcorrection. In the RR group, 34 (92%) of 37 patients were successfully aligned, two (5%) had undercorrection, and one (3%) had an overcorrection at 3 years after surgery. There was a statistically significant difference in postoperative results between the two groups (p = 0.0012). The cumulative probabilities of surgical success at 3 years postoperatively analyzed using the Kaplan-Meier survival curve were 63% in the BLR group and 92% in the RR group. Postoperative mean recurrence time was 45 months in the BLR group and 50 months in the RR group, showing a significant difference between the two groups (p = 0.0006).Conclusions: The unilateral RR procedure demonstrated more favorable long-term postoperative outcomes than BLR procedure in patients with large-angle IXT.

Comparison of Unilateral Versus Bilateral Lateral Rectus Recession for Small Angle Intermittent Exotropia: Outcomes and Surgical Dose-Responses.

To compare the surgical outcomes of unilateral lateral rectus recession to bilateral lateral rectus recession for small angle intermittent exotropia. This was a retrospective cohort study of pediatric patients with an intermittent exotropia between 16 and 20 prism diopters (PD) who underwent unilateral lateral rectus recession or bilateral lateral rectus recession at a single tertiary care pediatric hospital. The primary outcome was success (exotropia < 10 PD of esotropia < 5 PD, no decrease in stereopsis > 0.6 log arcsec, and no reoperation) at 12 months postoperatively. Secondary outcomes included survival analysis of time to surgical failure, surgical dose-response, and improvement in central fusion or stereopsis. At 12 months, successful outcomes were achieved in 13 of 27 patients (46%) in the bilateral lateral rectus recession group and 19 of 28 patients (70%) in the unilateral lateral rectus recession group, which was not a statistically significant difference (P = .10). Survival analysis showed a trend toward a higher rate of failure in the bilateral lateral rectus recession group compared to the unilateral lateral rectus recession group (P = .04). The mean surgical dose-response was 1.7 PD/mm at 1 week and 1.0 PD/mm at 12 months for the bilateral lateral rectus recession group, and 2.0 PD/mm at 1 week postoperatively and 1.4 PD/mm at 12 months postoperatively for the unilateral lateral rectus recession group. There were no cases of long-term postoperative lateral incomitance in either group. Unilateral lateral rectus recession and bilateral lateral rectus recession have similar success rates for small angle intermittent exotropia after at least 12 months of follow-up. Randomized controlled trials in surgical management of intermittent exotropia should consider unilateral lateral rectus recession as a treatment arm. [J Pediatr Ophthalmol Strabismus. 2022;59(5):350-355.].

Long term surgical outcomes of unilateral recession-resection versus bilateral lateral rectus recession in basic-type intermittent exotropia in children

The long-term results of surgical treatment of intermittent exotropia (X(T)) according to the type of surgery are controversial. We conducted a retrospective cohort study to compare the long-term results between unilateral recession-resection (RR) and bilateral lateral rectus recession (BLR) with an average follow-up of 9.5 years in children with basic-type X(T). Patients with basic-type X(T), who underwent RR (RR group) or BLR (BLR group) and were followed-up for more than 5 years postoperatively, were analyzed. Of the 560 patients, 363 patients received BLR and 197 patients underwent RR. There was no significant difference in the success rates between the two groups until postoperative 3 years. At an average of 9.5 ± 2.6 years after surgery, the success rate of the RR group was significantly higher than that of the BLR group starting from the fourth post-operative year until the last follow-up examination (64.5% vs 43.3%, P < 0.001). By multivariate analysis, preoperative hyperopia of more than + 2.00 diopters, younger age of onset, younger age at surgery, larger exodeviation at near than at distance of > 5 prism diopters, and the type of surgery (BLR) were risk factors of recurrence. In conclusion, RR was more successful than BLR with a lower recurrence rate in the long-term follow-up of patients with basic-type X(T).

Comparison of surgical outcomes between bilateral recession and unilateral recession-resection in moderate-angle intermittent exotropia

To compare postoperative drift after bilateral lateral rectus recession (BLR) and after unilateral recession combined with medial rectus resection (R&R) in children with primary moderate-angle intermittent exotropia. The medical records of children with intermittent exotropia in the range of 25Δ-50Δ who underwent BLR or R&R from July 2015 to September 2016 were reviewed retrospectively. Outcomes were classified according to postoperative angle of deviation at distance as overcorrection (esophoria or -tropia of >5Δ), success (esophoria or -tropia of ≤5Δ to exophoria/tropia of ≤10Δ), or recurrence (exophoria or -tropia of >10Δ). Patients were examined on postoperative day 1 and at 6weeks, 6months, and 12months. Sensory status was evaluated using the Titmus stereoacuity test. A total of 330 children were included (BLR, 175; R&R, 155). Exotropic drift was greater in the R&R group in the period between day 1 and 6weeks and from 6 to 12months (P <0.05). Surgical successful rates in each group were comparable: 57.7% in the BLR group and 60.6% in the R&R group (P>0.05). However, higher overcorrection rates were noted in the BLR group at 6 and 12months (16.6% vs 6.5 % at 12months [P=0.003]). There were more patients with deteriorated stereopsis after surgery in the BLR group (P=0.025). In our study cohort, BLR was associated with more stable long-term ocular alignment and a higher rate of overcorrection than R&R. Postoperative day 1 overcorrection of <16Δ following R&R and of <10Δ following BLR were associated with relatively good results.

A Randomized Trial Comparing Bilateral Lateral Rectus Recession versus Unilateral Recess and Resect for Basic-Type Intermittent Exotropia

To compare long-term outcomes after bilateral lateral rectus recession (BLRc) or unilateral lateral rectus recession combined with medial rectus resection in the same eye (R&R) for primary treatment of childhood intermittent exotropia (IXT). Multicenter, randomized clinical trial. One hundred ninety-seven children 3 to younger than 11 years of age with basic-type IXT, a largest deviation by prism and alternate cover test at any distance of 15 to 40 prism diopters (PD), and near stereoacuity of at least 400 seconds of arc. Random assignment to BLRc or R&R and masked examinations conducted every 6 months after surgery for 3 years. Proportion of participants meeting suboptimal surgical outcome by 3 years, defined as: (1) exotropia of 10 PD or more at distance or near using simultaneous prism and cover test (SPCT); or (2) constant esotropia of 6 PD or more at distance or near using SPCT; (3) loss of 2 octaves or more of stereoacuity from baseline, at any masked examination; or (4) reoperation without meeting any of these criteria. Cumulative probability of suboptimal surgical outcome by 3 years was 46% (43/101) in the BLRc group versus 37% (33/96) in the R&R group (treatment group difference of BLRc minus R&R, 9%; 95% confidence interval [CI], -6% to 23%). Reoperation by 3 years occurred in 9 participants (10%) in the BLRc group (8 of 9 met suboptimal surgical outcome criteria) and in 4 participants (5%) in the R&R group (3 of 4 met suboptimal surgical outcome criteria; treatment group difference of BLRc minus R&R, 5%; 95% CI, -2% to 13%). Among participants completing the 3-year visit, 29% (25 of 86) in the BLRc group and 17% (13 of 77) in the R&R group underwent reoperation or met suboptimal surgical outcome criteria at 3 years (treatment group difference of BLRc minus R&R, 12%; 95% CI, -1% to 25%). We did not find a statistically significant difference in suboptimal surgical outcome by 3 years between children with IXT treated with BLRc compared with those treated with R&R. Based on these findings, we are unable to recommend one surgical approach over the other for childhood IXT.

Effect of strabismus surgery on refractive power of the eye

Background The aim was to evaluate the refractive and corneal topographic changes occurring in the eyes after horizontal rectus muscle surgery, either unilateral recess–resect procedure or bilateral rectus muscle recession. Patients and methods A total of 31 eyes of 20 patients were included in this study. The patients underwent strabismus surgery for concomitant horizontal strabismus (exotropia). The patients were divided into two groups. Group A included nine patients (nine eyes), who were subjected to lateral rectus muscle recession and medial rectus resection in the same eye (R&R group). Group B included 11 patients (22 eyes) who were subjected to lateral rectus recession in both eyes (bilateral lateral rectus recession group). A full ophthalmic examination including cycloplegic automated refraction was carried out. Refraction and keratometry were assessed at 1–2 weeks preoperatively and 1 week, 1 month, and 3 months postoperatively. Corneal topography was performed before and 3 months after the operation. Preoperative and postoperative refraction was compared in terms of spherical equivalent (SE) and cylindrical power. Results The SE showed a transient statistically insignificant change toward the myopic side in the first week in both groups; these changes persisted for 2 months postoperatively and stabilized at the third month. However, the difference in SE from the preoperative values was statistically insignificant in both groups. Also, the changes in the refractive status that occurred when two muscles were operated in the same eye (R&R group) were greater than when only one muscle was operated. Conclusion Refractive status changed postoperatively, but this change was small and reversible.

Comparison of long‐term surgical outcomes of 2‐muscle surgery in intermittent exotropia: Bilateral vs Unilateral

PurposeTo compare long‐term surgical outcomes after bilateral lateral rectus recession (BLR) and unilateral lateral rectus recession‐medial rectus resection (RR) for the treatment of intermittent exotropia.MethodsConsecutive patients who underwent BLR or RR for treatment of intermittent exotropia between 1999 and 2010 and had ≥ 5 years’ follow‐up were recruited. Surgical outcomes were grouped according to postoperative angle of deviation as overcorrection (esophoria/tropia&gt;5△), success (esophoria/tropia ≤5△ to exophoria/tropia≤10△), or undercorrection/recurrence (exophoria/tropia&gt;10△), and were compared between the BLR group and the RR group at postoperative 1 week, 1 month, 6 months, 1 year, 2 years, 3 years, 4 years, 5 years, and at the final examination.ResultsOf 99 patients, 37 underwent BLR and 62 underwent RR. The mean follow‐up period was 99.6 months in the BLR group and 96.2 months in the RR group. At 1 week, 6 months, 1 year, 2 years, 3 years, 4 years, 5 years and at the final examination the surgical outcomes in each group were not different (p &gt; 0.05). The surgical success rate was 44.6% in the BLR group and 45.0% in the RR group (p = 0.27). The re‐operation rate was 29.7% in the BLR group and 40.3% in the RR group (p = 0.67).ConclusionsSurgical outcomes by 5 years after surgery for intermittent exotropia were comparable between the BLR and RR groups. The surgical success rate and the re‐operation rate were not different between the BLR and RR groups.

Effect of Inferior Oblique Weakening Procedures Combined with Surgery for Intermittent Exotropia

Purpose: To investigate whether combining inferior oblique weakening procedures with bilateral lateral rectus recession as a surgical approach to intermittent exotropia enhances postoperative horizontal angle of deviation over bilateral lateral rectus recession alone. Methods: Patients were allocated to one of two surgical groups: a bilateral lateral rectus recession group (Group 1) or a bilateral lateral rectus recession with bilateral inferior oblique weakening group (Group 2). Group differences in the angle of distance deviation were evaluated preoperatively and at 3and 12-months postoperatively. Results: There were no significant differences in preoperative factors or angles of deviation between Group 1 (n = 98) and Group 2 (n = 77); no significant intergroup difference in the angle of deviation was observed at any postoperative time point (p > 0.05). Conclusions: Combined inferior oblique weakening procedures did not significantly influence the horizontal angle of deviation after surgery for intermittent exotropia. Accordingly, there is no need to revise the surgical amount of lateral rectus recession. J Korean Ophthalmol Soc 2015;56(2):249-253

Long-term postoperative outcomes of bilateral lateral rectus recession vs unilateral recession-resection for intermittent exotropia.

To discuss the long-term postoperative results of bilateral lateral rectus recession (BLR) and unilateral lateral rectus recession-medial rectus resection (RR) in therapy of intermittent exotropia. We retrospectively analyzed 213 cases of intermittent exotropia who underwent surgery between 2008 and 2010. The patients were grouped into BLR group and RR group. Motor outcomes were divided into three groups on the basis of the angle of deviation after surgery: overcorrection (esotropia/phoria >5(Δ)), orthophoria (esotropia/phoria ≤5(Δ) to exotropia/phoria ≤10(Δ)), and undercorrection/recurrence (exotropia/phoria >10(Δ)). Titmus test was used to evaluate stereoacuity, the stereoacuity <800s of arc meaned the patients had stereopsis. Surgical outcome including motor criteria and sensory status were compared at postoperative 6, 12, 24mo and at 36mo examination between groups. At 12, 24mo after surgery, the motor outcomes had no difference (P>0.05) between groups. However, the motor outcomes at 6, 36mo were signally different in each group, indicating the success rate in RR group at 6mo was higher than that in BLR group (83.02% vs 82.24%, P<0.05) but the result was contrary at the 3y examination (60.75% vs 43.40%, P<0.05). No statistical significance were found in the sensory outcomes between the groups at mean of 3.7y follow-up. The motor outcomes in RR group were better than in BLR group at 6mo after surgery, while the 3y outcomes were better in BLR group. This may be due to the recurrence rate of the BLR was lower than the RR group's.

Comparison of Long-term Surgical Outcomes of 2-muscle Surgery in Children With Large-angle Exotropia: Bilateral vs Unilateral

To evaluate the long-term results of 2-muscle surgery in children with primary large-angle exotropia, comparing 10 mm bilateral lateral rectus recession (BLR) with unilateral lateral rectus recession-medial rectus resection (recess/resect). Retrospective case series. Eighty-six children with exotropia of ≥40 prism diopters (PD), who underwent the 10 mm BLR (BLR group) or the unilateral recess/resect procedure (RR group) based on the largest angle measured at distance or near were included. Patients were followed-up for more than 2 years. Final successful alignment rates, stereopsis, and factors related to recurrence and overcorrection were evaluated. At the final examination, 29 (60.4%) of 48 patients in the BLR group achieved successful alignment; 16 (33.3%) had recurrence, and 3 (6.3%) had overcorrection. In the RR group, 26 of 38 patients (68.4%) were successfully aligned, 10 (26.3%) had recurrence, and 2 (5.3%) had overcorrection. Successful alignment and recurrence rates were not significantly different in the groups (P = .371 and .640, respectively). The overcorrection rate was significantly higher in the RR group (P = .014) until 2 years after surgery, but this difference was not significant afterward (P = 1.000). In patients with an exodeviation of ≥45 PD, the recess/resect procedure showed higher successful alignment rates at the final examination (P = .006). The long-term successful alignment rate of 2-muscle surgery in children with primary large-angle exotropia was 64%, and the overall surgical outcomes were comparable between the BLR and RR groups. However, in patients with exotropia of ≥45 PD, the unilateral recess/resect procedure resulted in more favorable long-term outcomes.

The Long-Term Outcome of Lateral Rectus Advancement in Patients with Consecutive Esotropia Following Bilateral Lateral Rectus Recession for Intermittent Exotropia

Purpose: To investigate the long-term outcome of lateral rectus (LR) advancement for consecutive esotropia following bilateral LR recession for intermittent exotropia. Methods: Medical records of 25 patients who underwent LR advancement for consecutive esotropia after bilateral LR recession and who were followed up for more than 24 months postoperatively were reviewed. Patients were divided into two groups: bilateral lateral rectus recession (BLR) group included 16 patients with consecutive esotropia greater than or the same magnitude as the initial exotropia and who underwent bilateral LR advancement; Unilateral lateral rectus recession (ULR) group included nine patients with consecutive esotropia less than the initial exotropia and who underwent unilateral LR advancement. Main outcome measurements were motor and sensory outcomes and the dose-effect relationship calculated from observed overall and group changes in the angle of deviation per millimeter. Motor success was defined as alignment from orthotropia to exodeviation less than 10 PD at distance. Sensory outcome was described by comparing the Titmus stereoacuity test before and after LR advancement. Sensory successvwas defined at 100 seconds of arc. Results: Eighteen patients (72.0%) showed satisfactory long-term motor and sensory outcomes. Seventeen (77.3%) of 22 patients showed favorable stereopsis of 100 seconds of arc or more at final observation. The long-term motor success rate of the ULR group was better than that of the BLR group (p = 0.025). The average observed change in the angle of deviation was 3.6 PD/mm at the final visit in all patients. A greater dose-effect relationship was observed in the ULR group than in the BLR group at the final visit (p = 0.043). Conclusions: LR advancement showed favorable motor and sensory outcomes in the majority of patients. The surgical outcome was not favorable in patients in the BLR group with consecutive esotropia of the same magnitude as the initial exotropia. These results require further investigation for verification. J Korean Ophthalmol Soc 2014;55(8):1180-1186

The Long-Term Survival Analysis of Bilateral Lateral Rectus Recession Versus Unilateral Recession-Resection for Intermittent Exotropia

To conduct a comparison of the long-term surgical outcomes of bilateral lateral rectus recession (BLR) vs unilateral lateral rectus recession-medial rectus resection (RR) in treatment of intermittent exotropia. Nonrandomized, retrospective case series. Consecutive patients who underwent BLR or RR for treatment of intermittent exotropia between 2002 and 2006 and had ≥2 years' follow-up were recruited. Surgical outcomes were grouped according to postoperative angle of deviation as overcorrection (esophoria/tropia >5 Δ), success (esophoria/tropia ≤5 Δ to exophoria/tropia ≤10 Δ), or undercorrection/recurrence (exophoria/tropia >10 Δ), and were compared between the BLR group and the RR group at postoperative 1 day, 1 month, 6 months, 1 year, and 2 years, and at the final examination. Of 128 patients, 55 underwent BLR and 73 underwent RR. The mean follow-up period was 44.2 months in the BLR group and 47.8 months in the RR group. At 1 day, 1 month, 6 months, 1 year, and 2 years after surgery, surgical outcomes in each group were not different (P > .05) However, the final outcome at a mean of 3.8 years was significantly different between the groups, demonstrating a higher success rate in the BLR group than in the RR group (58.2% vs 27.4%, P < .01). Cumulative probability of survival from recurrence was higher in the BLR group than in the RR group (P = .01, log-rank test). Recurrences were most common within 6 months from surgery; however, after that, recurrences occurred continuously in the RR group and rarely in the BLR group. Surgical outcomes by 2 years after surgery for intermittent exotropia were not different between the BLR and RR groups. However, final outcomes were better in the BLR group than in the RR group. This may be caused by the difference of recurrence rate over time: continuous recurrence of exotropia occurred in the RR group, while recurrence was low in the BLR group after postoperative 6 months.